Prospective Study Comparing The Efficacy Of Cyanoacrylate Glue Injection Versus Conventional Fistulectomy In Management Of Patients With Fistula In Ano

Abstract

BACKGROUND : Fistula in ano is amongst one of the earliest lesions to be recognized. It is accepted that majority of them occur due to suppuration of anal glands which open into the anal crypts. Fistula-in-Ano is the most common and an intriguing problem of the Ano-rectal region in general population. Cyanoacrylate glue injection for fistula in ano is beneficial as one of the modalities of treatment with respect to ease of applicability, cost effectiveness ,less pain, sparing of sphincters, early recovery and low complications compared to conventional procedures like fistulectomy. OBJECTIVES: To compare the efficacy of cyanoacrylate glue versus conventional fistulectomy in patients with fistula in ano with respect to  Post operative Pain  Perianal wound/scar  Duration of hospital stay  Maintenance of continence  Recurrence of fistula at 6 months follow-up time  Cost effectiveness of the procedure MATERIAL AND METHODS: Patients admitted with fistula in ano were allocated to study group (Cyanoacrylate glue injection) and control group (Fistulectomy) alternatively.  Detailed history was taken, thorough clinical examination was done and relevant investigations were performed for all the patients in both the study and control groups.  A Proforma was used to collect all the relevant data from the patients both preoperatively and post operatively. All cases were followed up to discharge and subsequently at 1st month, 3rd month and 6th month. RESULTS: Mean age for fistula in ano was found to be 35.8years , male is to female ratio is 2:1 , Intersphicteric fistula is most common type of fistula,,there is significant difference between mean pain score in patient treated with glue injection (1.3)and those treated with fistulectomy(6.4).No complication was seen in patients treated with cyanoacrylate glue injection where as patients treated with fistulectomy had complications.Success rate of both procedures is about 90.2%. CONCLUSION: Given its safety profile ,ease of application ,simplicity ,less postoperative pain, reduced duration of hospital stay, early recovery , low complication rate and post operative morbidity cyanoacrylate glue injection should be considered in the management of fistula in ano and is better than fistulectomy in these aspects.